Evaluation of the Hepatotoxic Effect of Long-Term Use of Statins Based on the Results of Shear Wave Elastometry

Abstract

Statins have been used in clinical practice for more than a quarter of a century. Over this period, their positions in various clinical guidelines have significantly strengthened. First, this group of drugs was used exclusively for the treatment of patients with a pronounced increase in the levels of atherogenic lipoproteins, but over time, the indications for their prescription have expanded considerably as well as the tactics of their use. The aim of our work is to determine the effect of statin therapy on hepatic tissue fibrosis in patients with steatohepatosis. We examined 87 patients (43 women and 44 men) with non-alcoholic steatohepatosis and liver fibrosis. The average age of the patient was 46.2 ± 4.6 years. The studies were carried out at the scientific and practical centre of the Department of Family Medicine and Therapy, Poltava State Medical University, and the Rheumatology Centre, Poltava Region Clinical Hospital. The severity of liver fibrosis was established based on 2D shear wave elastometry by transcutaneous shear wave approach in SWE mode using a convex transducer tuned to 3.5 MHz on an Ultima PA Expert ultrasound scanner (Radmir, Ukraine). The level of "stiffness" of the liver parenchyma by SWE was measured in kPa. The study included patients with liver fibrosis F2-F3 according to METAVIR. All patients received statin therapy during the study: 22 patients received rosuvastatin at a daily dose of 20 mg, 21 patients received atorvastatin at a daily dose of 20 mg, 22 patients received simvastatin at a daily dose of 20 mg, and 22 patients received lovastatin in a daily dose of 20 mg. In addition to a decrease in the level of low density lipoproteins, total cholesterol, triglycerides, systemic and long-term use of statins under the adequate treatment of steatohepatosis has led to a decrease in the severity of fibrotization of the hepatic parenchyma that is confirmed by both shear wave elastometry data and the scale data. At the same time, the difference between the indicators after the therapy in the groups of patients receiving rosuvastatin, simvastatin, atorvastatin and lovastatin showed no signs of reliability that may indicate a positive effect of inhibition of hydroxymethylglutaryl coenzyme A reductase on the progression of fibrotic changes. The use of statins in the integrated therapy of patients with steatohepatitis, in addition to normalizing the plasma lipid profile, can reduce the fibrotic changes in the liver parenchyma. It should be noted that there is no advantage to any of the medicines we investigated. Moreover, the statins used did not produce hepatotoxic effects.